Flashcards in Shoulder Deck (39):
Based on cadaver dissection
Neer- impingement occurs where?
Repeated impingement of the cuff and numeral head and traction on the coracoacromial ligament
Neer- which muscle tendon is most frequently involved?
Neer- what is the critical zone?
Elevation of the arm at 70 degrees where the critical zone pass under the CA lig and anterior process of acromion
Neer- what the dx usually?
What is the Hawkins-Kennedy impingement test testing?
Glenohumeral impingement or supraspinatus/paratenonitis
What is the procedure for the Hawkins test?
Pt seated or standing, arm resting at side
PT passively flexes shoulder to 90 degrees, flex elbow to 90 degrees and internally rotate shoulder
What does the compression test (O’Brien’s) test?
Detects SLAP lesion
Whaat is the procedure for the compression test?
Pt seated/standing with arm held at 90 degrees flexion and full elbow extension
Arm is horizontally adducted 10-15 degrees and medically rotated so thumb points downward
PT applies downward force to the arm
Arm is laterally rotates so palms up and PT applies downward force
Why would someone present with a positive finding with the thumbs down position versus palms up? (Compression test)
Compressing the space, make sure to differentiate the difference between AC and labral pathology
Test for rotator cuff tear
What’s a positive finding for drop arm?
Pt unable to slowly lower, ratchety movement, severe pain
Empty can test
Test for supraspinatus/muscle neuropathy of nerve
What are the pathologies of a rotator cuff tear?
Intrinsic cuff problem
Supraspinatus weakens and degenerates with age
Fatigues with use in athletes
Overpowering by deltoid causes superior migration of numeral head
Impingement with secondary bony changes
What are some causes of rotator cuff tears?
Trauma- shoulder dislocation, prox numeral fx, scapular fx
Instability (labral tears)
What is the progression for a rotator cuff tear?
Starts at the critical zone ->supraspinatus ->progress with further tension -> infraspinatus -> subscap
What population of people are more likely/at risk to tear their RC
>40 yrs and sedentary people doing light work
What is anterior traumatic instability
Instability caused by hyperabduction-external rotatory forces
What is the result of anterior traumatic instability?
Capsulolabral avulsion at the 3-6 o’clock position on the glenoid
Anterior traumatic instability- high or low rate of recurrence?
High (94%) if youre <20
What is a bankart lesion?
Labrum and capsule avulsed from glenoid
Labral complex floats freely
*associated with dislocation, bony lesion*
What are the stages of impingement?
I -> edema and hemorrhage
II -> fibrosis & tendinitis
III -> AC Spur and RC tear
What are some pain management tx?
NSAIDS, is, iontophoresis, subacromial injections
Pain, motion, strength, scapular control, strength
What is the operative tx of impingement?
Debride subacromial bursa
Remove impinging structures (osteophytes, coracoacromial ligament)
Early post op strengthening
Open vs arthroscopic
WHat are some benefits of arthro decompression?
decrease deltoid morbidity, lower narcotic requirements, lower hospital costs, earlier return of ROM, directly assess jt.
What’s the post op course?
Depends on quality of tissue and strength of repair
Begin early PROM
Scap stabilizer strength
1st 6 wks- PROM
2nd 6 wks- resisted iso
After 3 mo- healed
What is a SLAP tear?
Associated with biceps rupture, mainly a labral tear.
What is the apprehension test (crank test)?
Determine integrity of glenoid labrum & anterior inferior capsule
Pt Abd & ER
Feels like it may slip
What is the fulcrum test?
Determine anterior instability
Pt supine do 90/90
+if increased motion/local pain
What accounts for 4% of GH dislocations?
Posterior, also a recurrent post sublux
What does someone with a posterior dislocation have pain with?
Flexion, add, IR
What are some tests to test for posterior dislocations?
Load & shift test
What are the grades of instability?
0 no translation
1 (mild)= numeral head moves slightly up face of glenoid 0-1 cm translation
2 (mod)= numeral head rides up but not over the rim (1-2cm)
3 (severe)= humeral head rides over glenoid rim
Reduced when stress is removed
WHat is adhesive capsulitis?
Most limited in shoulder ABd & ER
What are common comorbidities of frozen shoulder?
DM and hypothyroidism
What is the tx for frozen shoulder?
Reduce pain (NSAIDS, injections)
Strengthen after motion returned
Post op procedure for frozen shoulder?
Pain pump (scalene block)
What are the indications for surgery post fx?
-articulate involvement (2mm+)
Age, activity lvl, hand dominance